Ostomy Nutrition Guide

Introduction

This handout is designed to help answer questions you may have about the way diet affects your ostomy. Our hospital dietitians and enterostomal therapists are health professionals specially trained to help you and your family with any dietary concerns, both while you are in the hospital and after you are discharged. If you have any questions regarding your diet, call your dietitian or your physician’s office.

General Information

Eating is one of life’s great pleasures. Having an ostomy should not change your enjoyment of food. Most people with ostomies return to their normal diet soon after the operation. Many individuals with ostomies can enjoy a normal diet within 6 weeks of surgery; however, food tolerances can vary from person to person.

The following general guidelines will help make caring for your ostomy easier:

Eat meals regularly. You should eat three or more times a day. An ostomy works best this way and produces less gas.

Chew your food well. Chewing well will help to avoid a blockage at your stoma site. If you have an ileostomy, be especially careful when chewing foods that may be hard to digest or foods that have a high fiber content.

Try new foods one at a time. Learn which foods may give you annoying side effects such as excess gas, constipation, a looser stool, or odor. If a new food seems to give you problems, eliminate it for a few weeks, but try it again later. You may find something else was causing your problem.

Avoid gaining excess weight. Once you’re on the road to recovery, you should avoid gaining excess weight. Extra weight is not good for your ostomy, and it can cause health problems in general.

Drink a lot of fluid daily. You may lose more body fluids than usual through the stoma, so it is important to drink a lot of fluid. Ileostomy patients and colostomy patients who have lost a large part or all of their large intestine will especially notice more fluid loss. This is because most of the body’s fluid is normally reabsorbed in the large intestine.

Above all, remember that no two people will react the same to foods. You will learn through experience which foods, if any, you should avoid. It may be helpful to keep a list of foods that you try and write down how they make you feel.

Preventing Blockage

There are no real restrictions to your diet, unless you experience a problem with a particular food. The possibility of blockage of the stoma is usually only a concern if you have an ileostomy. Certain foods, if eaten in large amounts or not chewed well, may cause a blockage at the stoma opening.

Use caution when eating the following foods, because they are not completely digestible and could cause blockage:

Nuts and Seeds

Popcorn

Dried Fruit

Coconut

Raisins

Peas

Chinese Vegetables

Vegetable Skins

Salad Greens

Celery

Coleslaw

Raw Pineapple

Mushrooms

Relishes

Corn

You do not need to avoid these foods. Just eat small amounts and be sure to chew them well.

Reducing Odor

If you experience a problem with odor, you may try making some changes in your diet. Cleanliness and odor-resistant appliances also play a big part in controlling odor. The following are known to produce odor:

Alcohol

Cauliflower

Asparagus

Broccoli

Fish

Brussel Sprouts

Cabbage

Onions

Baked Beans

Cheese

Eggs

If you experience a problem after eating one of these foods, try a small amount again in a few weeks. Always experiment before cutting out your favorite foods.

Buttermilk, parsley, kefir, and yogurt may help reduce odor. You can include one of them in your daily diet.

Certain vitamins and drugs can cause odor, so remind your doctor that you have an ostomy when he is prescribing medication for you.

Reducing Gas

Everyone produces gas along with bowel movements. Some gas is normal, and should be expected. If excess gas becomes a problem for you, it can be controlled to some degree by your diet. Factors such as when and how you eat certain foods can help reduce gas production. Try following these tips:

Eat regularly. Skipping meals is likely to produce gas.

Avoid swallowing air while eating. You can do this by taking your time when eating. Relax and don’t talk with your mouth full.

Avoid chewing gum or drinking through a straw.

The following foods and beverages may cause excess gas. If you are bothered by gas, you can try eliminating these foods altogether or you can try to avoid having more than one of them at one meal. Again, do not eliminate these foods unless you are sure they are really responsible for the unpleasant side effects.

Asparagus

Beer

Broccoli

Brussel Sprouts

Cabbage

Cauliflower

Cucumbers

Dried Peas and Beans

Fish

Melons

Milk

Nuts

Onions

Radishes

Soda

Sweets

Relieving Constipation

Constipation (stools that are small, dry, and/or hard to pass) is a different problem from blockage (undigested food blocking the stoma). If you have a colostomy, a certain amount of fiber in your diet is needed to add bulk to your stools and make them easy to pass. Mild constipation can be treated by adjusting your diet in the following ways:

Some people find that coffee, chocolate, lemon juice, licorice, or prune juice will help constipation.

Exercise often helps, even if it is only a little extra walking.

Diarrhea

The consistency of your stools is determined to a certain extent by the location of your stoma in your gastrointestinal (GI) tract. Normally, when the stoma is higher up in the GI tract, the stools tend to be looser. In some cases, a loose stool may be the result of eating certain foods. The following foods can cause loose stools:

Baked Beans

Beer

Broccoli

Chocolate

Dried Beans

Licorice

Prune Juice

Soup

Red Wine

Hot Beverages

Heavily Spiced Foods

Very Large Meals

Any food that gave you loose stools before your ostomy may continue to do so. Remember to test a small amount of a suspected food again in a few weeks to be sure it really does trouble you.

The following foods may help when you are experiencing diarrhea:

Applesauce

Bananas

Boiled Milk

Cream of Rice

Peanut Butter

Rice

Tapioca

Weak Tea

Loose stools can also result from emotional upset, traveling, and impure water (which can be a problem if you travel abroad). Diarrhea can also be caused by illnesses like the flu. If you are losing a lot of fluid through your ostomy because of the flu or other problems, be sure to drink plenty of liquids, such as tea, bouillon or broth and ginger ale. If diarrhea continues for more than 24 hours, call your doctor.

A Special Note for Ileostomy Patients

It is very easy to quickly lose large amounts of water, minerals and vitamins through an ileostomy when diarrhea occurs. Losing too much fluid can lead to a condition called dehydration (dee-hi-DRAY-shun), which can be dangerous. Your fluid and mineral losses need to be replaced so that you do not become dehydrated. The following recipe is for a beverage that you can drink when you lose large amounts of fluid through your ileostomy. You can also drink Gatorade®, which is available in most supermarkets.

Beverage recipe

1 teaspoon salt

4 teaspoons corn syrup

1 teaspoon baking soda

1 six-ounce can of frozen orange juice

Mix all the ingredients together and add enough water to make one quart.

Potassium and Sodium

These two minerals are lost daily with the fluids that leave your body through your ileostomy. They can be replaced by adding foods high in potassium and sodium to your daily diet. Talk with your doctor if you follow a diet that restricts potassium or sodium. He or she will advise you of any special instructions for your condition. Good dietary sources of potassium and sodium are listed below:

Foods High in Potassium

Milk

Beef

Chicken

Duck

Fish

Lamb

Pork

Veal

Turkey

Green Beans

Lima Beans

Broccoli

Brussels Sprouts

Potatoes

Peppers

Spinach

Tomatoes

Tomato Juice

V8 Juice®

Apricot Nectar

Apricots

Avocado

Bananas

Cantaloupe

Cherries

Dates

Figs

Grapefruit

Grapefruit Juice

White Grapes

Nectarines

Oranges

Orange Juice

Peaches

Peach Nectar

Pineapple

Plums

Prunes

Prune Juice

Rhubarb

Strawberries

Watermelon

Foods High in Sodium

When used in cooking or at the table, salt is the most obvious source of dietary sodium. Other seasonings are also good sources of sodium. They include:

Chili Sauce

Gravy Flavorings

Ketchup

Meat Tenderizers

Monosodium Glutamate

Salts (celery, onion, garlic)

Soy Sauce

Worcestershire Sauce

Foods that have salt added during processing are also good sources of dietary sodium. They include:

Ham

Bacon

Hot Dogs

Sausage

Cold Cuts, Corned Beef

Canned Meat, Fish, Stew

Pickles

Relish

Olives

Crackers

Pretzels

Salted Popcorn

Cheese

TV Dinners

Vegetables in Brine

Peanut Butter

Salad Dressing

Sauerkraut

Canned and Dried Soup

Gravy

Sauces

Pickled Foods

Scrapple

Tomato Juice

Tomato Sauce

V8 Juice

Low Fiber Foods

Eating foods that are low in fiber may help prevent irritation of your digestive tract including diarrhea. Use these guidelines as a reference when selecting low-fiber foods:

If these suggestions do not relieve episodes of irritation or diarrhea within a day or two, call your doctor.

Other General Information

Special diets

Your doctor may order a special diet for you for reasons other than your ostomy. For example, there are diets to help control high blood pressure, diabetes, and heart disease. Make sure you check with your dietitian about following these special diets.

Red spots

Some ostomy patients have mistakenly thought they were bleeding when they noticed red spots in their stools. Certain foods such as red peppers, pimientos, and beets may show up as red particles in your stools. These particles may be mistaken for blood. If you are unsure, call your doctor.

Traveling

If you travel to a foreign country, you should first check with your doctor, enterostomal therapist, or dietitian. You may encounter food and water that are impure, and you may need special advice on what to do to prevent problems.

Fluids

Drink more fluids in hot weather and when you exercise to help replace excess fluid loss, particularly if you have an ileostomy.

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

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